question

A patient is admitted with nausea, vomiting, and abdominal pain. The physician documents on the discharge summary; acute cholecystitis, nausea, vomiting, and abdominal pain. Which of the following would be the correct coding sequence for this case? Acute cholecystitis, nausea vomiting, abdominal pain Abdominal pain, vomiting, nausea, acute cholecystitis Nausea, vomiting, abdominal pain Acute cholecystitis

answer

Acute cholecystitis

question

A 60 yo male is admitted with a history of prostate cancer and with mental confusion. The patient completed radiation therapy three years ago is status post a radical resection of the prostate. A CT scan of the brain during the current admission reveals metastatic. Which of the following is the correct coding and sequencing for the current hospital stay? Metastatic carcinoma of the brain; carcinoma of the prostate; mental confusion Mental confusion; history of carcinoma of the prostate; admission for chemotherapy Metastatic carcinoma of the brain; history of carcinoma of the prostate Carcinoma of the prostate; metastatic carcinoma of the prostate

answer

Metastatic carcinoma of the brain; history of carcinoma of the prostate

question

A 7yo female is admitted to the emergency department for shortness of breath and wheezing. The patient is treated with epinephrine and nebulizer treatments without relief of the symptoms. What diagnosis should be suspected: Acute bronchitis Acute bronchitis with chronic obstructive pulmonary disease Asthma with status asthmaticus Chronic obstructive asthma

answer

Asthma with status asthmaticus

question

The practice of using a code that results in a higher payment to the provider than the code that actually reflects the service or item provided is known as: (Points : 5) Unbundling Upcoding Medically unnecessary services Billing for services not provided

answer

Upcoding

question

A 75 year old male is admitted with fever, lethargy, hypotension, tachycardia, oliguria, and elevated WBC. The patient has more than 100,000 organisms of Escherichia coli per cc of urine. The attending physician documents "urosepsis." How should the coder proceed? Code sepsis as the principal diagnosis and urinary tract infection due to E coli as a secondary diagnosis. Code urinary tract infection with sepsis as the principal diagnosis Query the physician to ask if the patient has septicemia because of the symptomatology Query the physician to ask if the patient had septic shock so that this may be used as the principal diagnosis.

answer

Query the physician to ask if the patient has septicemia because of the symptomatology

question

Uniform reporting and statistical data collection for medical procedures, supplies, products, and services are promoted by which of the following? Current Procedural Terminology Healthcare Common Procedure Coding System International Classification of Diseases, Ninth Revision, Clinical Modification International Classification of Diseases for Oncology, Third Edition

answer

Healthcare Common Procedure Coding System

question

Malignant disease is used exclusively for classifying cases based upon which of the following classifications? CPT HCPCS ICD-9-CM ICD-O-3

answer

ICD-O-3

question

A 50 yo female is admitted with abdominal pain. The physician states that the discharge diagnosis is pancreatitis versus noncalculus cholecystitis. Both diagnoses are treated equally. The correct coding and sequencing of the case would be: Sequence either the pancreatitis or the noncalculus cholecystitis as the principal diagnosis Pancreatitis; noncalculus cholecystitis; abdominal pain Noncalculus cholecystitis; pancreatitis; abdominal pain Abdominal pain; pancreatitis; noncalculus cholecystitis

answer

Sequence either the pancreatitis or the noncalculus cholecystitis as the principal diagnosis

question

A patient is admitted for spotting. She was treated two weeks previously for a miscarriage with sepsis. The sepsis had resolved and she I afebrile at this time. She is treated with an aspiration dilation and curettage in which products of conception are found. Which of the following would be the principal diagnosis? Miscarriage Complications of spontaneous abortion with sepsis Sepsis Spontaneous abortion with sepsis

answer

Miscarriage

question

The following system provides detailed classification system for coding of the histology, topography, and behavior of neoplasm? (Points : 5) Current Procedural Terminology Healthcare Common Procedure Coding System International Classification of Disease for Oncology, Third Edition Systematized Nomenclature of Medicine Clinical Terminology

answer

International Classification of Disease for Oncology, Third Edition

question

If a T status procedure was performed, how much would the facility get reimbursed for the second T procedure under the APC payment? 0% 50% 75% 100%

answer

100%

question

Updating the procedure classification of ICD-9-CM is done by which of the following? Centers for Disease Control (CDC) Centers for Medicare and Medicaid Services (CMS) National Center for Health Statistics (NCHS) World Health Organization (WHO)

answer

Centers for Medicare and Medicaid Services (CMS)

question

When coding a hydrocystoma of the eyelid, which of the following codes would be used? 216 Benign Neoplasm of Skin Includes: Blue nevus Dermatofibroma Hydrocystoma Pigmented nevus Syringoadenoma Syringoma Excludes: Skin of genital organs (221.0-222.9) 216.0 Skin of lip Excludes: Vermilion border of lip (210.0) 216.1 Eyelid, including canthus Excludes: Cartilage of eyelid (215.0) 216 210.0 215.0 216.1

answer

216.1

question

A 50 yo male, with a history of lung cancer, is admitted to the hospital with ataxia and syncope and a fractured arm as a result of falling. The patient undergoes a closed reduction of the fracture in the emergency department in addition to undergoing a complete workup for metastatic carcinoma of the brain. The patient is found to have metastatic carcinoma of the lung to the brain and undergoes radiation therapy to the brain. Which of the following would be the principal diagnosis in this case? Ataxia Fractured arm Metastatic carcinoma of the brain Carcinoma of the lung

answer

Metastatic carcinoma of the brain

question

What type of closure includes retention sutures according to CPT? Complex Intermediate Not specified Simple

answer

Complex

question

The most comprehensive controlled vocabulary for coding the content of a patient record would be which of the following? CPT HCPCS ICD-9-CM SNOMED-CT

answer

SNOMED-CT

question

Which of the following is the definition of "other diagnoses" according to the UHDDS? Is recorded in the patient record Is documented by the attending physician Receives clinical evaluation or therapeutic treatment or diagnostic procedures or extends the length of stay or increases nursing care and/or monitoring Is documented by at least two physicians and/or the nursing staff

answer

Receives clinical evaluation or therapeutic treatment or diagnostic procedures or extends the length of stay or increases nursing care and/or monitoring

question

If a medication list contains the drug Procardia, which of the following diagnosis should the coder find? Hypertension Esophagitis Congestive Heart Failure AIDS

answer

Hypertension

question

Substance abuse and mental health disorders are collected by which set of codes? CPT DSM-IV-TR HCPCS SNOMED CT

answer

DSM-IV-TR

question

Which of the following is the planned replacement for ICD-9-CM volumes 1 and 2? Current Procedural Terminology (CPT) International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) International Classification of Diseases, Tenth Revision (ICD-10) International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM)

answer

International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM)

question

A patient is admitted with abdominal pain with diarrhea and was diagnosed with infectious gastroenteritis. The patient also had angina and chronic obstructive pulmonary disease. Which of the following would be the correct coding and sequencing of this case? Abdominal pain; infectious gastroenteritis; chronic obstructive pulmonary disease; angina Infectious gastroenteritis, chronic obstructive pulmonary disease; angina Gastroenteritis; abdominal pain; angina Gastroenteritis; abdominal pain; diarrhea; chronic obstructive pulmonary disease; angina

answer

Infectious gastroenteritis, chronic obstructive pulmonary disease; angina

question

ICD-9 was originally published by? American Medical Associations (AMA) Centers for Disease Control (CDC) United States federal government World Health Organization (WHO)

answer

World Health Organization (WHO)

question

A patient presents to the doctor's office with fever, productive cough and shortness of breath. The physician orders a chest x-ray and indicates in the progress note: "Rule Out pneumonia" If the results have not yet been received, what should the coder report for the visit? Pneumonia Fever, cough, shortness of breath Cough, shortness of breath Pneumonia, cough, shortness of breath, fever.

answer

Fever, cough, shortness of breath

question

The CPT code determined for the excision of a malignant lesion of the skin is by the body area and by which of the following? Length of the lesion as described in the pathology report Dimension of the specimen submitted as described in the pathology report Width times the length of the lesion as described in the operative report Diameter of the lesion as well as the margins excised as described in the operative report

answer

Diameter of the lesion as well as the margins excised as described in the operative report

question

When coding a benign neoplasm of skin of the vermilion border of the lip, which of the following codes should be used? 216 Benign Neoplasm of Skin Includes: Blue nevus Dermatofibroma Hydrocystoma Pigmented nevus Syringoadenoma Syringoma Excludes: Skin of genital organs (221.0-222.9) 216.0 Skin of lip Excludes: Vermilion border of lip (210.0) 216.1 Eyelid, including canthus Excludes: Cartilage of eyelid (215.0) 216 210.0 216.0 216.1

answer

210.0

question

Which of the following is also known as Title XVIII of the Social Security Act Amendment of 1965? Medicare Medicaid Medigap SCHIP

answer

Medicare

question

Eligibility standards for enrollment in Medicaid is established by which of the following? Centers for Medicare and Medicaid Services (CMS) Department of Health and Human Services (HHS) Federal government Individual states

answer

Individual states

question

Which of the following allows subscribers to seek healthcare services from providers outside the network at a higher level of copay, though they encourage the subscriber to select providers from a prescribed network? ASO POS PPO TRICARE

answer

POS

question

What is the maximum number of payment tiers based on severity as determined by the presence of a major complication/comorbidity, a CC; or no CC? Two Three Four Five

answer

Three

question

Which of the following healthcare programs cover dependents and survivors of permanently and totally disabled veterans? CHAMPUS CHAMPVA HIS TRICARE

answer

CHAMPVA

question

Which of the following program provides additional federal funds to states so that Medicaid eligibility can be expanded to include a greater number of children? Medigap PACE SCHIP TRICARE

answer

SCHIP

question

The amount of payment determined before the service is delivered is considered which of the following payment systems? Fee-for Service Per diem Prospective Retrospective

answer

Prospective

question

What does it mean for a provider to accept assignment? Patient authorizes payment to be made directly to the provider Provider accepts as payment in full whatever the payer reimburses Balance filling is allowed on patient accounts, but at a limited rate Participating provider receives a fee-for-schedule reimbursement

answer

Provider accepts as payment in full whatever the payer reimburses

question

Diagnosis-related groups (DRGs) are organized into _______________. Case-mix classifications Geographic practice cost indices Major diagnostic categories Resource-based relative values

answer

Major diagnostic categories

question

Which of the following is the name of the federally funded program that pays medical bills of spouses and dependents of persons on active duty in the uniformed services? HHS-CMS TRICARE CHAMPVA Medigap

answer

TRICARE

question

Which one of the following requires the present on admission (POA) indicator? Inpatient Medicare claims submitted by all hospitals. Inpatient Medicare and Medicaid claims submitted by hospitals Medicare claims submitted by all entities Inpatient skilled nursing facility Medicare claims

answer

Inpatient Medicare claims submitted by all hospitals.

question

Healthcare cost and lost income associated with work-related injuries is covered by which of the following healthcare? CHAMPVA Medicare Medicaid Workers' compensation

answer

Workers' compensation

question

The Medicare inpatient prospective payment system excludes which of the following types of hospitals? Children's Rural State supported Tertiary

answer

Children's

question

What is the purpose of the present on admission (POA) indicator? Differentiate between conditions present on admission and conditions that develop during an inpatient admission. Track principal diagnoses Distinguish between principal and primary diagnoses. Determine principal diagnosis

answer

Differentiate between conditions present on admission and conditions that develop during an inpatient admission.

question

According to the Medicare outpatient prospective payment system does not reimburse for which of the following? CMHC partial hospitalization services Critical access hospitals Hospital outpatient departments Vaccines provided by CORFs

answer

Critical access hospitals

question

How is the Medicare benefit period defined? Beginning the day the Medicare patient is admitted to the hospital and ending when the patient has not been hospitalized for a period of sixty consecutive days The period in which a Medicare patient is hospitalized The period that begins on January 1 of each year with an allowable inpatient hospitalization benefit up to 90 days Between one and 90 days of a Medicare patient's hospitalizations

answer

Beginning the day the Medicare patient is admitted to the hospital and ending when the patient has not been hospitalized for a period of sixty consecutive days

question

In processing a Medicare payment for outpatient radiology exams a hospital outpatient services department would receive payment under which of the following payment systems? DRGs HHRGS OASIS OPPS

answer

OPPS

question

Medicare fee schedule is associated with which of the following? APCs MS-DRGs RBRVS RUG-III

answer

RBRVS

question

Third-party payers update fee schedules how often? Annually Monthly Semiannually Weekly

answer

Annually

question

Which of the following groups of health care providers contracts with a self-insured employer to provide healthcare services? Independent Practice Association Health Maintenance Organization Point-of-service provider Preferred provider organization

answer

Preferred provider organization

question

American Indians and Alaskan natives are provided healthcare services by which of the following? CMS IHS NIH VA

answer

IHS

question

Payment of inpatient services is utilized by which of the following prospective payment systems? APC DRG OPPS RBRVS

answer

DRG

question

In the Inpatient Prospective Payment System the assignment to a DRG begins with the __________________________. Principal diagnosis Primary diagnosis Secondary diagnosis Surgical procedure

answer

Principal diagnosis

question

Which of the following is most likely to be used in performing an outpatient coding review? OCE MS-DRG CMI MDS

answer

OCE

question

The phrase "aging of accounts" refers to accounts that have been: Billed but not paid Discharged but not billed Admitted but not discharged Paid but not credited

answer

Billed but not paid

question

A patient was diagnosed with L4-L5 lumbar neuropathy and discogenic pain. The patient underwent an intradiscal electrothermal annuloplasty (IDET) in the radiology suite. What ICD-9-CM procedure code is used? 721.42, Spondylosis with myelopathy, lumbar region 722.10 Displacement of lumbar intervertebral disc without myelopathy 80.59, Other destruction of intervertebral disc 388, Pain not elsewhere classified

answer

80.59, Other destruction of intervertebral disc

question

Most facilities begin counting days in accounts receivable at which of the following times? The date the patient registers The date the patient is discharged The date the bill drops The date the bill is received by the payer

answer

The date the bill drops

question

In processing a bill for healthcare services which of the following would be excluded under Medicare Part A? Dental services Home health services Hospice services Hospitalization services

answer

Dental services

question

Which of the following is NOT one of the purposes of ICD-9-CM Identification of supplies, products, and services provided to patients Classification of morbidity for statistical purposes Classification of mortality for statistical purposes Reporting of diagnoses by physicians

answer

Identification of supplies, products, and services provided to patients

question

Which of the following statements best describes an integrated delivery system? A system of healthcare delivery that ensures that patients obtain appropriate cost-effective services A group of healthcare organizations that collectively provides a full range of coordinated health-related services A healthcare system that contracts directly with physicians in an independent practice or with one or more multispecialty group practices A healthcare system made up of two or more hospitals that are owned by the same organization

answer

A group of healthcare organizations that collectively provides a full range of coordinated health-related services

question

A patient is admitted to the hospital with shortness of breath and congestive heart failure. The patient subsequently develops respiratory failure and is intubated and placed on ventilator management. Which of the following would be the correct code sequencing and coding in this care? Congestive heart failure, respiratory failure, ventilator management, intubation Respiratory failure, intubation, ventilator management Respiratory failure, congestive heart failure, intubation, ventilator management Shortness of breath, congestive heart failure, respiratory failure, ventilator management

answer

Congestive heart failure, respiratory failure, ventilator management, intubation

question

The sum of the hospital's relative DRG rates for a year was 15,192 and the hospital had 10,471 discharges for the year. Given this information what would be the hospital's case-mix index for that year? 0.689 0.689 x 100 1.45 x 100 1.45

answer

1.45

question

Which of the following coding error classifications is most valuable in determining the impact on overall revenue cycle? Errors by coding guideline Percentage of cases that could have been improved if queried Errors by coders Errors that produced changes in the MS-DRG assignment

answer

Errors that produced changes in the MS-DRG assignment

question

The unique number that identifies each service or supply in the CDM and links each item to a particular department is known as the: Revenue code General ledger key Charge code Item description

answer

Charge code

question

In preparing a bill for Mr. Smith's healthcare services, the health record technician needs to determine those services to be paid under Medicare Part A and those under Medicare Part B. Which of the following services should be processed under Part B? Inpatient hospitalization care Inpatient laboratory and radiology services Skilled nursing facility care Surgeon's services

answer

Surgeon's services

question

Coding productivity consists of: Accuracy and volume Accuracy Volume CMI

answer

Accuracy and volume

question

Which of the following is associated with Medicare SNF prospective payment? CMGs DRGs RBRVS RUG-III

answer

RUG-III

question

An HIM director is requesting the purchase of a document imaging system. However, the Hospital Budge Committee is reluctant to approve the request because of the expense. The committee feels that the money is better spent implementing CPOE and other EHR applications. Which of the following might the HIM director use as a cost-benefit justification? The EHR system will take too long to implement The Joint Commission requires that the hospital move to digital scanning Discharged not final billed and accounts receivable days can be improved because of workflow efficiencies HIPAA requires the use of digital tracking of release of information

answer

Discharged not final billed and accounts receivable days can be improved because of workflow efficiencies

question

The deception or misrepresentation by a healthcare provider that may result in a false or fictitious claim for inappropriate payment by Medicare or other insurers for items or services either not rendered or rendered to a lesser extent than described in the claim is: Healthcare fraud Optimization Upcoding Healthcare abuse

answer

Healthcare fraud

question

The patient had a placenta previa with delivery of twins. The patient had two prior Cesarean sections and this C-section was due to hemorrhage. The principal diagnosis would be: Normal delivery Placenta previa Twin gestation Vaginal hemorrhage

answer

Placenta previa

question

In processing a bill under the Medicare outpatient prospective payment system (OPPS), where a patient had three surgical procedures performed during the same operative session, which of the following would apply? Bundling of services Outlier adjustment Pass-through payment Discounting of procedures

answer

Discounting of procedures

question

Continuing coding education is required for: Credentialed coders Inpatient coders All coders Inpatient and ambulatory surgery coders

answer

All coders

question

Which of the following would a health record technician use to perform the billing function for a physician's office? Screen 837P or CMS1500 UB-04 UB-92 Screen 8371 or UB-04

answer

Screen 837P or CMS1500

question

A patient has carcinoma of multiple overlapping sites of the bladder. A diagnostic cystoscopy and transurethral fulgeration of the bladder lesion (1.9cm, 6.0cm) are undertaken. Which of the following CPT code(s) would be most appropriate? 52000 Cystourethroscopy 52224 Cystourethroscopy with fulguration (including cryosurgery or treatment of) minor (less than 0.5cm) tumor(s) with or without a biopsy 52234 Cystourethroscopy with fulguration (including cryosurgery or treatment of) small ( 0.5cm to 2.0cm) tumor(s) with or without a biopsy 52235 Cystourethroscopy with fulguration (including cryosurgery or treatment of) medium (2.0cm to 5.0cm) tumor(s) with or without a biopsy 52240 Cystourethroscopy with fulguration (including cryosurgery or treatment of) large bladder tumors with or without a biopsy 52234, 52240 52235 52240 52200, 52234, 52240

answer

52240

question

In most instances, the "owner" of the Charge Description Master (CDM) in a healthcare facility is the: HIM department Information technology department Finance department Patient accounts department

answer

Finance department

question

The APC payment system is based on what coding system? CPT/HCPCS codes ICD-9-CM diagnosis and procedure codes CPT and ICD-9-CM procedure codes Only CPT codes

answer

CPT/HCPCS codes

question

The amount charged for a medical insurance policy is which of the following? Fee schedule Premium Claim Deductible

answer

Premium

question

The first step in an inpatient record review is to verify the correct assignment of the: Record sample Coding procedures Principal diagnosis DRG

answer

Principal diagnosis

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